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大剂量静脉注射拉贝洛尔对手术期间血糖的影响。

The effect of high dose intravenous labetalol on plasma glucose during surgery.

作者信息

Chung P C, Sum D C

机构信息

Department of Anesthesia, Chang Gung Memorial Hospital, Taipei.

出版信息

Ma Zui Xue Za Zhi. 1993 Dec;31(4):233-6.

PMID:8302148
Abstract

As high dose intravenous labetalol was always used in performing deliberate hypotensive anesthesia and it was reported that small dose of intravenous labetalol would decrease the hyperglycemic response under surgical stress, high dose intravenous labetalol may theoretically causes more pronounced reduction in plasma glucose. 14 female cervical cancer patients (ASA physical status I-II) undergoing radical total hysterectomy were selected and randomly assigned into two groups (group A and group B). The anesthesia was induced with 2.5% sodium thiopental 4 mg/kg, atropine 0.3 mg, succinylcholine 1.5 mg/kg and fentanyl 3 micrograms/kg intravenously. The anesthesia was maintained with isoflurane, nitrous oxide, oxygen and vecuronium under artificial controlled ventilation. Radial artery was cannulated for continuous blood pressure monitoring and blood sampling. The first sample was taken after intubation and before skin incision and the second sample was taken 5 minutes after skin incision in group A and after giving total dose of labetalol in group B, other blood samples were taken every 30 minutes thereafter. No labetalol was given in group A patients. In group B, labetalol (1.0-1.5 mg/Kg) was administrated intravenously in repeated bolus (10 mg/bolus) to achieve a mean blood pressure around 60 torr after skin incision. All the fluid administered intraoperatively was free of glucose. Any patients with blood loss greater than 1000 ml or having blood transfusion before the 5th samples (S5) were excluded because stored blood was rich of glucose. The result revealed that plasma glucose rose significantly in both groups but the rise occurred later in group B.(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

由于在实施控制性低血压麻醉时一直使用大剂量静脉注射拉贝洛尔,且有报道称小剂量静脉注射拉贝洛尔可降低手术应激下的高血糖反应,理论上大剂量静脉注射拉贝洛尔可能会使血糖水平更显著降低。选取14例接受根治性全子宫切除术的ASA身体状况为I-II级的女性宫颈癌患者,随机分为两组(A组和B组)。静脉注射2.5%硫喷妥钠4mg/kg、阿托品0.3mg、琥珀酰胆碱1.5mg/kg和芬太尼3μg/kg诱导麻醉。在人工控制通气下,用异氟烷、氧化亚氮、氧气和维库溴铵维持麻醉。插入桡动脉进行连续血压监测和采血。A组在插管后、皮肤切开前采集第一份样本,在皮肤切开后5分钟采集第二份样本;B组在给予拉贝洛尔总剂量后采集第二份样本,此后每30分钟采集其他血样。A组患者不给予拉贝洛尔。B组静脉重复推注拉贝洛尔(1.0 - 1.5mg/Kg,每次推注10mg),使皮肤切开后平均血压达到约60托。术中输入的所有液体均不含葡萄糖。任何失血超过1000ml或在第5份样本(S5)之前接受输血的患者被排除,因为库存血富含葡萄糖。结果显示,两组患者的血糖均显著升高,但B组升高出现得较晚。(摘要截短至250字)

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